
<div class="row mt-5">
    <div class="col-lg-12">
    <div class="content">
        <nav aria-label="breadcrumb">
            <ol class="breadcrumb nav_bar">
                <li class="">当前位置&nbsp;:&nbsp;&nbsp;</li>
                <li class="breadcrumb-item"><a href="shop-orderlist.html">我的订单</a></li>
                <li class="breadcrumb-item active product_name"><a href="javascript:void(0);"></a></li>
                <li class="breadcrumb-item active" aria-current="page">申请退还积分</li>
            </ol>
        </nav>
    </div>
        <section class="panel bg-white">
            <header class="panel-heading">申请退还积分</header>
            <div class="panel-body mt-3">

                <form action="#">
                    <div class="form-group row canday-row" id="way-group">
                        <label class="col-sm-2 col-form-label">处理方式</label>
                        <div class="col-sm-10">
                            <div class="input-group mb-3">
                                <div class="input-group-prepend">
                                    <label class="input-group-text" for="way-input">请选择</label>
                                </div>
                                <select class="custom-select" id="way-input">
                                            <option value="1" selected>我要退还积分但不退货（未收到货)</option>>
                                            <option value="2">我要退还积分并退货</option>
                                        </select>
                            </div>
                        </div>


                    </div>
                    <div class="form-group row canday-row">
                        <label class="col-sm-2 col-form-label">退还积分原因</label>
                        <div class="col-sm-10">
                            <textarea type="text" class="form-control" id="reason-input" placeholder="请输入原因" style="resize:none;" rows="3" maxlength="300" required></textarea>
                            <div class="invalid-feedback" id="reason-input-invalid">

                            </div>
                        </div>
                    </div>
                    <div class="form-group row canday-row">
                        <label class="col-sm-2 col-form-label">手机号</label>
                        <div class="col-sm-10">
                            <input type="text" class="form-control" id="contact-input" placeholder="" maxlength="20" required>
                            <span class="application_back_phone d-none">请输入正确的手机号</span>
                        </div>

                    </div>

                    <input type="submit" class="send-button btn-style ml-3 bcat_defaul_backgroundcolor btn confirm" id="application-btn" value="确认"
                    />
                </form>
            </div>
        </section>
    </div>

</div>